Preservation of swallowing function with de-intensified chemoradiation therapy for HPV-associated oropharyngeal squamous cell carcinoma
Purpose: This study aimed to compare the swallowing function in patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma treated with de-intensified chemoradiation therapy (6 weeks, 60 Gy) versus those receiving standard-of-care chemoradiation therapy (7 weeks, 70 Gy). Met...
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Elsevier
2018-07-01
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Series: | Advances in Radiation Oncology |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109418300381 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Greg D. Judy, MD Rebecca Green, MSW Shannon L. Aumer, MA Robert J. Amdur, MD Xianming Tan, PhD Nathan Sheets, MD Mark Weissler, MD Adam Zanation, MD Samip Patel, MD Trevor Hackman, MD William M. Mendenhall, MD Bhishamjit S. Chera, MD |
spellingShingle |
Greg D. Judy, MD Rebecca Green, MSW Shannon L. Aumer, MA Robert J. Amdur, MD Xianming Tan, PhD Nathan Sheets, MD Mark Weissler, MD Adam Zanation, MD Samip Patel, MD Trevor Hackman, MD William M. Mendenhall, MD Bhishamjit S. Chera, MD Preservation of swallowing function with de-intensified chemoradiation therapy for HPV-associated oropharyngeal squamous cell carcinoma Advances in Radiation Oncology |
author_facet |
Greg D. Judy, MD Rebecca Green, MSW Shannon L. Aumer, MA Robert J. Amdur, MD Xianming Tan, PhD Nathan Sheets, MD Mark Weissler, MD Adam Zanation, MD Samip Patel, MD Trevor Hackman, MD William M. Mendenhall, MD Bhishamjit S. Chera, MD |
author_sort |
Greg D. Judy, MD |
title |
Preservation of swallowing function with de-intensified chemoradiation therapy for HPV-associated oropharyngeal squamous cell carcinoma |
title_short |
Preservation of swallowing function with de-intensified chemoradiation therapy for HPV-associated oropharyngeal squamous cell carcinoma |
title_full |
Preservation of swallowing function with de-intensified chemoradiation therapy for HPV-associated oropharyngeal squamous cell carcinoma |
title_fullStr |
Preservation of swallowing function with de-intensified chemoradiation therapy for HPV-associated oropharyngeal squamous cell carcinoma |
title_full_unstemmed |
Preservation of swallowing function with de-intensified chemoradiation therapy for HPV-associated oropharyngeal squamous cell carcinoma |
title_sort |
preservation of swallowing function with de-intensified chemoradiation therapy for hpv-associated oropharyngeal squamous cell carcinoma |
publisher |
Elsevier |
series |
Advances in Radiation Oncology |
issn |
2452-1094 |
publishDate |
2018-07-01 |
description |
Purpose: This study aimed to compare the swallowing function in patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma treated with de-intensified chemoradiation therapy (6 weeks, 60 Gy) versus those receiving standard-of-care chemoradiation therapy (7 weeks, 70 Gy). Methods and materials: A retrospective review was conducted of 78 patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma with modified barium swallow studies pretreatment and 6 to 8 weeks posttreatment. The swallowing function was objectively scored for penetration, aspiration, and pharyngeal residue. Forty patients received de-intensified chemoradiation therapy (60 Gy image guided radiation therapy with weekly cisplatin 30 mg/m2) and 38 patients received standard-of-care chemoradiation therapy (70 Gy image guided radiation therapy with chemotherapy of the medical oncologist's choosing). Univariate and multivariate analyses were performed to detect differences between the cohorts with regard to laryngeal penetration, aspiration, and pharyngeal residue. A multivariate logistic regression was used to determine the overall effect of treatment on the swallowing function. Patient-reported swallowing outcomes in de-intensified cohort were assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Module for Head and Neck Cancer and the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events questionnaires. Results: Patients treated with de-intensified chemoradiation therapy were associated with a suggestion of lower risk of developing overall swallowing dysfunction (odds ratio [OR], 0.62; P = .07), laryngeal penetration (OR, 0.63; P = .12), and pharyngeal residue (OR, 0.61; P = .08). The mean pre- and 2-year post-European Organisation for Research and Treatment of Cancer Quality of Life scores pertaining to swallowing (1-4 scale, higher worse) in the de-intensified cohort were 1.4 and 1.2 for liquids; 1.2 and 1.1 for purees; 1.5 and 1.7 for solids, 1.0 and 1.3 for choked when swallowing; and 9.0 and 10.8 for composite score, respectively. The mean pre- and 2-year post-Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events swallowing difficulty scores (1-5 scale, with higher scores being worse) were 1.5 and 1.8, respectively. Conclusions: Compared with 7 weeks of 70 Gy, 6 weeks of 60 Gy de-intensified chemoradiation therapy appears to better preserve the baseline swallowing function (per objective modified barium swallow assessment). Patients treated with de-intensified chemoradiation therapy reported minimal changes in swallowing function. |
url |
http://www.sciencedirect.com/science/article/pii/S2452109418300381 |
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doaj-5548c015e5c2440bba6b108d6fa4aa932020-11-25T00:06:26ZengElsevierAdvances in Radiation Oncology2452-10942018-07-0133356365Preservation of swallowing function with de-intensified chemoradiation therapy for HPV-associated oropharyngeal squamous cell carcinomaGreg D. Judy, MD0Rebecca Green, MSW1Shannon L. Aumer, MA2Robert J. Amdur, MD3Xianming Tan, PhD4Nathan Sheets, MD5Mark Weissler, MD6Adam Zanation, MD7Samip Patel, MD8Trevor Hackman, MD9William M. Mendenhall, MD10Bhishamjit S. Chera, MD11Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina; Corresponding author. University of North Carolina Hospitals, 101 Manning Drive, CB #7512, Chapel Hill, NC 27599.Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North CarolinaDepartment of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North CarolinaDepartment of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida; Shands Cancer Center, University of Florida Hospitals, Gainesville, FloridaLineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North CarolinaREX/UNC Healthcare, Raleigh, North CarolinaDepartment of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North CarolinaDepartment of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North CarolinaDepartment of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North CarolinaDepartment of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North CarolinaDepartment of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida; Shands Cancer Center, University of Florida Hospitals, Gainesville, FloridaDepartment of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North CarolinaPurpose: This study aimed to compare the swallowing function in patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma treated with de-intensified chemoradiation therapy (6 weeks, 60 Gy) versus those receiving standard-of-care chemoradiation therapy (7 weeks, 70 Gy). Methods and materials: A retrospective review was conducted of 78 patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma with modified barium swallow studies pretreatment and 6 to 8 weeks posttreatment. The swallowing function was objectively scored for penetration, aspiration, and pharyngeal residue. Forty patients received de-intensified chemoradiation therapy (60 Gy image guided radiation therapy with weekly cisplatin 30 mg/m2) and 38 patients received standard-of-care chemoradiation therapy (70 Gy image guided radiation therapy with chemotherapy of the medical oncologist's choosing). Univariate and multivariate analyses were performed to detect differences between the cohorts with regard to laryngeal penetration, aspiration, and pharyngeal residue. A multivariate logistic regression was used to determine the overall effect of treatment on the swallowing function. Patient-reported swallowing outcomes in de-intensified cohort were assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Module for Head and Neck Cancer and the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events questionnaires. Results: Patients treated with de-intensified chemoradiation therapy were associated with a suggestion of lower risk of developing overall swallowing dysfunction (odds ratio [OR], 0.62; P = .07), laryngeal penetration (OR, 0.63; P = .12), and pharyngeal residue (OR, 0.61; P = .08). The mean pre- and 2-year post-European Organisation for Research and Treatment of Cancer Quality of Life scores pertaining to swallowing (1-4 scale, higher worse) in the de-intensified cohort were 1.4 and 1.2 for liquids; 1.2 and 1.1 for purees; 1.5 and 1.7 for solids, 1.0 and 1.3 for choked when swallowing; and 9.0 and 10.8 for composite score, respectively. The mean pre- and 2-year post-Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events swallowing difficulty scores (1-5 scale, with higher scores being worse) were 1.5 and 1.8, respectively. Conclusions: Compared with 7 weeks of 70 Gy, 6 weeks of 60 Gy de-intensified chemoradiation therapy appears to better preserve the baseline swallowing function (per objective modified barium swallow assessment). Patients treated with de-intensified chemoradiation therapy reported minimal changes in swallowing function.http://www.sciencedirect.com/science/article/pii/S2452109418300381 |